Racial and Ethnic Disparities in Cardiac Reintervention after Pediatric Cardiac Surgery.

BACKGROUND: Children undergoing cardiac surgery may require postoperative surgical or catheter-based reintervention prior to discharge. We examined racial/ethnic variations in reintervention and associated in-hospital mortality.

METHODS: Children undergoing cardiac surgery from 2004 to 2015 were identified in the Pediatric Health Information Systems (PHIS) database. Regression analysis measured associations between race/ethnicity, in-hospital mortality, and postoperative cardiac surgical or catheter-based reintervention (Surgery/Catheter Reintervention).

RESULTS: Of 124,263 patients, 8,265 (6.7%) had a Surgery/Catheter Reintervention. Black patients had fewer reinterventions (5.9% versus 6.7%) and higher in-hospital mortality (3.9% versus 2.7%, p<0.01) than White patients. After adjusting for sociodemographic and illness severity indicators, Black patients remained less likely to receive Surgery/Catheter Reintervention (adjusted Hazard Ratio [aHR] 0.89, 95% confidence interval [CI] 0.82-0.98) despite having similar risk of death after reintervention (adjusted Odds Ratio [aOR] 1.17, 95% CI 0.98-1.41) compared with White patients. Black and Other race/ethnicity patients also had higher risk of death without Surgery/Catheter Reintervention (aHR 1.26, 95% CI 1.08-1.47 and aHR 1.33, 95% CI 1.13-1.57, respectively) than White patients. Similar trends were demonstrated when mechanical circulatory support and cardiac transplantation were included as reinterventions.

CONCLUSIONS: Patients of Black and Other race/ethnicity undergoing pediatric cardiac surgery are more likely to die without postoperative cardiac reintervention than White patients. Black patients are also less likely to receive reintervention despite no significant difference in mortality with reintervention. Further studies should evaluate etiologies and methods of addressing these disparities.